Bristol was already a hot topic in the NHS when Labour came to power in 1997, and ministers have had some time to consider their next moves.

Well before the publication of the Bristol inquiry report, the government was making moves to beef up measures to protect patients.

Perhaps the most important change was the creation of the National Clinical Assessment Authority.

This started work in April 2001, and is supposed to provide a rapid response, including retraining, when doubts about a doctor's performance are raised.

Trusts can ask the agency to investigate cases it cannot handle locally and the Agency will bring in independent experts to examine the evidence.

Its findings will be passed to the trust or the General Medical Council.

Safety body

In addition, the National Patient Safety Agency (NPSA), set up just two weeks prior to the publication of Professor Sir Ian Kennedy's report, will play an important role.

Set up as a special health authority, The NPSA is there to try to cut down the number of medical accidents and other "adverse events" which could leave patients severely damaged, or even dead.

It will collect information about problems, and try to train staff to learn from mistakes already made elsewhere.

The NPSA will look out for the procedures which carry the highest risks of errors - and produce guidelines to reduce them.

Memory game

The principles behind the agency were introduced by a report called "An Organisation with a Memory", which detailed how mistakes and even "near misses" - in which no harm came to patients, should be collated, so that safeguards could be built in to the system.

Bristol was described as a "system failure", both in the inquiry report and by Health Secretary Alan Milburn on the day of its release.

Rather than simply the actions of a few doctors, the problem had developed because there were no checks and balances in place to raise the alarm when things first started to go wrong.

Mr Milburn said: "There was a tragic combination of key clinicians failing to reflect on their own performance, senior management failing to grasp the seriousness of what was going wrong, and people in various official capacities - including the Department of Health, - failing to act."

He has begun to address what is often regarded as a lack of accountability among NHS managers, and willingness to take their share of responsibility for the performance of doctors.

A code of conduct for managers has been promised - managers breaking it could be sacked.

In addition, trust boards can now also be replaced if the Department of Health feels that the hospital is failing.

Progress on checks

At the other end, the GMC is still working on a system by which doctors would regularly prove that they are still fit to practice, keeping their skills up to date with the latest medical advances.

This "revalidation" system has yet to be implemented, but the GMC has brought in a way to quickly suspend doctors for whom there is evidence that they are a risk to the public.

However, as he presented the Bristol report to Parliament, Mr Milburn said he would be looking, in consultation with the GMC, at creating a new, overarching regulatory body to ensure the accountability of health care professionals.

The government's new arrangements for "patient power" in hospitals are due to be put in place in April this year.

The Patient Advocacy and Liaison Services (Pals) will work as part of a hospital trust to find out and act on the concerns of patients, and are part of the package which is expected to replace community health councils.

Place for children

There has also already been recognition that children in NHS hospitals need to be protected by new standards and guidelines.

Mr Milburn has appointed a national director of children's health to develop minimum standards for children in NHS hospitals - including for paediatric cardiac surgery.

The Bristol report said that it was possible that a similar scandal could be developing elsewhere in the NHS even now - a view shared by many in the NHS.

However, while leading doctors say it is impossible to rule this out, they believe that the entire climate under which medicine is practised in the UK has changed dramatically since the affair came to light.

While not impossible, they say that it would now be far more difficult for the environment in which scandal flourished to develop elsewhere.